Standard DoseOne 300 mg tablet once daily (or one 150 mg tablet twice daily), without regard to food. Dosing needs to be adjusted for adults and children who have decreased kidney function (creatinine clearance less than 50 mL/min). See package insert for guidance on dosing in the setting of kidney impairment. Must be taken in combination with another antiretroviral(s), which does not contain the medication in this drug.
According to the package insert, it is indicated for adults and children at least 3 months of age and older. Based on pediatric DHHS guidelines, it can be used as part of an empiric HIV regimen in infants of at least 32 weeks’ gestation at birth for higher risk perinatal HIV exposure. Epivir for children is dosed based on body weight. See the package insert and/or DHHS guidelines for weight-based dosing.
Take missed dose as soon as possible, unless it is closer to the time of your next dose. Do not double up on your next dose. The 150 mg tablets are scored and may be split. Based on drug properties, tablets may be crushed and added to a small amount of semi-solid food or liquid for immediate consumption. Epivir is also available as an oral solution (10mg/mL) (strawberry-banana flavor) for children and adults who are not able to swallow the tablets. Can be substituted for Emtriva.
AWPEpivir 300 mg tablets, 30 tablets: $498.89/month
generic lamivudine; 300 mg tablets, 30 tablets: $429.19/month
Potential Side Effects and Toxicity
- See package insert for more complete information on potential side effects and interactions.
Epivir is very well tolerated. The most common side effects with incidence greater than or equal to 15% were headache, diarrhea, nausea, malaise (general ill feeling), fatigue, nasal symptoms, diarrhea, and cough. If you have HIV and HBV, guidelines recommend treatment for both viruses. Emtriva can treat both HIV and HBV, but must be used in combination with another hepatitis B drug (such as tenofovir) to treat the hep B. If you are co-infected with HBV and HIV, you should not stop Epivir without medical supervision because it can cause your HBV to flare up and cause you to experience signs and symptoms of acute hepatitis. HBV should be closely monitored by your provider.
Potential Drug Interactions
No significant drug interactions. Epivir may be used with hepatitis C drugs such as Daklinza, Epclusa, Harvoni, Olysio, Sovaldi, Viekira Pak, or Zepatier, depending on the other components in the HIV regimen. Avoid use of sorbitol-containing medicines with lamivudine; there are many, such as acetaminophen liquid (Tylenol liquid and others).
Epivir (lamivudine) is similar to Emtriva (emtricitabine): both treat HIV and HBV and have the same resistance profile, meaning that if your virus is resistant to one drug, it will be resistant to the other. If your HIV develops resistance to lamivudine, it doesn’t mean that your HBV is also resistant to it. Sometimes, drug resistance that the virus develops against lamivudine makes the virus reproduce at a slower rate. This drug resistance can also improve the antiviral activity of Retrovir (zidovudine) and Viread (tenofovir), and for that reason, some providers continue Epivir treatment in combination with other antiretrovirals after resistance develops. Lamivudine is also available in several combination products: Cimduo (with tenofovir DF), Combivir (with zidovudine), Epzicom (with abacavir), Trizivir (with zidovudine and abacavir), Symfi and Symfi Lo (with tenofovir DF and efavirenz), Delstrigo (with tenofovir DF and doravirine), and Triumeq (with dolutegravir and abacavir). Epivir as part of the combination tablet Combivir is recommended as an alternative NRTI combination component of an ART regimen during pregnancy. Epivir is available as generic lamivudine, which should be as effective and well tolerated as the brand name drug Epivir. Some insurers may require patients to take regimens containing generics rather than brand name drugs, including simpler co-formulated products. For example, since both zidovudine (Retrovir, AZT) and lamivudine are available in generic form, a person might have to take these two generic pills instead of the fixed-dose combination tablet Combivir. The availability of generics might also limit choices of therapy. For example, newer brand name drugs and co-formulations, such as Genvoya or Triumeq, might be restricted to patients who can’t physically tolerate generic regimens.
See package insert for more complete information on potential side effects and interactions.
Dr. David Hardy says:
Epivir was approved in 1995 as the fourth antiretroviral medication and nuke. Due to its high potency and excellent tolerability (it has virtually no side effects), it has survived for 23 years as a commonly used antiretroviral as most other antiretrovirals approved during that time have fallen by the wayside due to toxicity. It has been available as generic lamivudine since 2011. As mentioned on the Emtriva page, due to their almost identical properties Emtriva and Epivir are almost interchangeable, including their high susceptibility to the very common M184V mutation in the virus. In a 2-drug regimen with Tivicay (see dolutegravir/3TC), Epivir was recently shown to be part of a successful 2-drug, non-protease inhibitor regimen for first-line therapy.
Activist Moisés Agosto-Rosario says:
Epivir, or lamivudine, is the oldest antiretroviral still in use today. It is well tolerated, very effective, and has no drug-drug interactions. It has been used in combination with other NRTIs like zidovudine (Combivir) and abacavir (Epzicom) and is a component of the single-tablet regimen Triumeq. It is used to treat individuals co-infected with HIV and HBV. It seems to work best in combination with other nukes as the backbone of a regimen. The only downside is its resistance profile. One mutation (M184V) can reduce its effectiveness.